This book describes Mitral Stenosis (A Heart Valve Disease), Diagnosis and Treatment and Related Diseases

Mitral Stenosis is a congenital valvular disease

Where the mitral valves release less blood and close tightly

Blood may leak slowly in the ventricle from the atrium

This may cause strain on the left atrial myocardium

The mitral valve makes a mid-late diastolic murmur

Loud first heart sound with an opening snap in early diastole

The tight valve flaps make a rumbling sound as they shut.

The echocardiogram show the valve movement in the heart

Treatment is to reduce the heart's workload by medications

Diuretic and digoxin are given to treat chest congestion or palpitations

Blood-thinning medicines reduce the risk of blood clots forming

Surgery is needed if the stenosed mitral valves reduce the blood flowing

-An original poem by Kenneth Kee

I had a patient who was found to have mitral stenosis only when she gave birth to her only daughter 30 years ago.

For 10 years she was treated with medication to improve the function of her heart without problem.

A new heart specialist saw her and decided that she was fit for valve replacement.

So after consulting with her family she went ahead with operation.

Her operation was only 90% successful. She had to take warfarin, a blood thinner for life and medical reviews every month initially and now every 6 monthly.

Mitral Stenosis (MS) is a disorder in which the mitral valve does not open fully inducing limitation of blood flow.

The mitral valve is the bileaflet valve that permits the blood from the upper chamber of the heart (left atrium) to flow into the lower chamber (left ventricle).

It then closes preventing blood from flowing backwards into left atrium.

Mitral stenosis indicates that the mitral valve cannot open adequately.

As a result less blood streams out of the heart to the body.

The upper heart chamber becomes swollen as pressure builds up.

Blood and fluid may then accumulate in the lung tissue (pulmonary edema) making it hard to breathe.

In adults mitral stenosis occurs most often in those who have had rheumatic fever which may develop after untreated or poorly treated streptococcal throat or scarlet fever.

The mitral stenosis develops 5-10 years or more after the incident of rheumatic fever

Calcification of the mitral valve leaflets

Congenital heart disease.

Infective endocarditis,

Mitral annular calcification,

Endomyocardial fibroelastosis,

Malignant carcinoid syndrome,

Symptoms are:

Breathlessness

Hemoptysis

Fatigue

Palpitations

Swelling of feet or ankles

Signs

Malar flush on the cheeks

Raised jugular venous pressure

Laterally displaced apex beat

Right ventricular heave

Heart sounds:typical of mitral stenosis are a loud first heart sound, an opening snap, and a diastolic rumble.

CXR: may show left atrial enlargement and interstitial edema (Kerley A and B lines)

Echocardiography is the most specific and sensitive study to diagnose and quantify the severity of mitral valve stenosis.

ECG

TEE (Trans-esophageal echocardiography)

Cardiac catheterization (seldom done now)

At present, no medical therapy can alleviate a fixed obstruction of the mitral valve

Diuretics

Beta-blockers,

Calcium channel blockers

Anticoagulants

Preventive antibiotics

Surgical treatment has improved survival rate of MS:

Mitral valvotomy (surgical or percutaneous)

Mitral valve replacement and repair (valvuloplasty)

TABLE OF CONTENT

Introduction

Chapter 1 Mitral Stenosis

Chapter 2 Causes

Chapter 3 Symptoms

Chapter 4 Diagnosis

Chapter 5 Treatment

Chapter 6 Prognosis

Chapter 7 Mitral Regurgitation

Chapter 8 Aortic Stenosis

Epilogue